Gillings Global Health Blog

Students and global health experts share their experiences working with communities.

Category: Zambia 2020

Life in the Era of Zoom

September 30, 2020 /

As I sat down to write this blog, it really hit me that it is already the end of September. It’s been over 6 months since this pandemic started and about 5 months since I began my practicum. Reflecting back, I entered this pandemic with feelings of uncertainty. Transitioning to classes online seemed fine at first since it was already classes we were used to. Since North Carolina cases were not as bad initially, I still saw my close friends safely and following guidelines. Nothing felt like an extreme change.

However, as time went on, the pandemic began to take its toll on me as it inevitably has on everyone else. Even simple things like going to the grocery store became a whole fiasco of timing it so the store isn’t crowded or being wary of grabbing takeout. As we began to bunker down even more strictly, it became hard to not feel frustrated at times.

Needing a break from North Carolina, I ended up going back to my parent’s place for a bit in New Jersey. When I relayed these feelings to my mom, she made a point that I hadn’t considered before. For the first time in over 6 years, I was actually home for more than one week.  I had never considered it given that I talk to my family frequently but once it came to my attention, I thought back to how much I’ve missed in my family life.

Daily walks with my mom and brother.

Daily walks with my mom and brother.

Thinking about this in terms of my practicum, if I had gone to Zambia this summer, I would have missed the time I spent with my family. Don’t get me wrong, I still would have loved to do my practicum in person. However, missing one opportunity allowed me multiple other ones. If I had gone to Zambia, I would’ve spent maybe a couple months then and returned. Despite the challenges that came with doing the practicum remotely, I had the privilege of seeing my project from start to finish. Remote work also allowed for continuity with the project so despite my practicum officially ending soon, I’ll be staying on a while longer to help finish papers. Even though the study I worked on was not the original study I had signed up to do my practicum with, I developed qualitative data analysis skills that I really feel are an assets to future work. Importantly as well, I developed friendships and networks through Zoom, something which I thought would be very difficult.

Learning how to cook different cuisines this summer!

Learning how to cook different cuisines this summer!

As I wind down on my official time with this practicum and work on my deliverables, I am really thankful for the opportunity to work with the Zambia hub. My practicum was everything I had wanted it to be and I got more out of it than I had expected from remote work. I’m grateful for both the community here at Gillings and in Zambia for making this summer a great one!

– Aditi

ALL’S WELL THAT ENDS WELL

August 26, 2020 /

It feels like just yesterday when I started my practicum and like the saying goes “everything that has a beginning, sure has an end.” I successfully completed my remote practicum on August 10, which also happened to be the first day of class for the Fall semester.

Working at honey suckle tea house.

Working at honey suckle tea house.

My practicum project was aimed at engaging male partners, grandmothers/family members in Lusaka, Zambia to support optimal infant feeding and stimulation of HIV-exposed uninfected infants as well as women’s continued ART adherence. I also participated in secondary analysis of qualitative data obtained from interviews with HIV-positive women and their male partners in Zambia and Malawi.

I am very excited to have worked on a project that is in line with my interest, which is improving the health of women and children with limited access to health care particularly in the areas of HIV/AIDS as well as Infant and Young Child Feeding (IYCF).

My outputs were counseling materials, training guides and qualitative data summaries. Though I could not make it to Zambia, I am so glad for how much I have learnt about the population, their traditions, beliefs and available community assets. This knowledge helped me to design materials bearing in mind the context of the public health problem as well as being culturally sensitive which would in turn ensure acceptability and sustainability of recommended practices.

I am extremely grateful to UNC Gillings Zambia Hub for this opportunity to broaden my knowledge, develop skills and apply my knowledge on a hands-on real work. I had an amazing preceptor, Dr. Stephanie Martin, who coached me excellently, shared very useful resources and provided constructive feedback on products. I am also grateful for the guidance and encouragement from my faculty mentor, Dr. Sian Curtis. Above all, I am thankful for good health, sound mind and the ability to adapt to change.

This practicum experience has been a great one, which I would not have traded for anything. I hope to eventually travel to Zambia one day!

Below is the new addition to family [I am a new plant mom (fig. 2)…lol] and also currently “plant-sitting” for a friend (fig.3).

Figure 2

Figure 2

Figure 3

Figure 3

– Doreen

When Everything Goes Digital

August 21, 2020 /

In March, my practicum in Zambia was moved to an online format. I was frustrated and disappointed because I had been so eager to go physically see oncological care in Sub-Saharan Africa. What I didn’t expect was to gain practical skills during such a hands-off internship. This summer I developed a digital dashboard system for a multidisciplinary team that had just transitioned to a virtual format as well. I was originally very frustrated with the world when my plans got altered to start remote work, instead of traveling, but I realized I was not the only one that was adjusting. To make their efforts more efficient in their new virtual state, and to address historical need for technology, I was employed to introduce a new way of communicating between the team, allowing them to share information at a moment’s notice. I soon realized that the whole world would be having to learn this, and use these skills for a bit longer than anticipated.

Through my efforts of developing the digital data management system, I have researched eHealth systems around the world, and I have seen how low and middle-income countries are focused on developing eHealth strategy documents. The purpose of these is to outline the need for building technological capacity and supporting tech education. It is a public statement to the world and the people that the country intends to step into the technological world. Recently Zambia started benefiting from a new undersea high speed internet cable that has now given the internet to millions of people. Much of the population is still rural, but the new connective cable allows Zambia to join countries like South Africa and Zimbabwe that are also connected.

A practicum like mine would not have been possible even a decade ago because of lack of internet, and the whole prospect of shifting the multidisciplinary team to virtual meetings would not have been possible without the development of software like Zoom that has become so prevalent during the pandemic. COVID-19 is waking the world up to the functional uses of the internet in professional settings. All those meetings that could have been emails are now emails, or virtual meetings. I wonder if the in-person meetings, or offices, will make a full recovery. Now looking for employment at the start of the Fall semester, many if not all opportunities are advertised as remote for the foreseeable future, and will probably transition to that mode from now on. Over the past three months, I have learned many things about the virtual world, but the most important, is that it is here to stay.

– Katerina

Global Research From A Local Office

June 15, 2020 /

The time of Covid-19 has brought unprecedented challenges to all aspects of life. Coming to Gillings and being in the global health concentration, I knew from the start that I wanted to go abroad for my practicum. To me, it was meant to be a learning experience in research in another culture and how public health campaigns are approached across the world. With the travel restrictions brought on by the global pandemic, going abroad was no longer an option but as disappointing as that was initially, my practicum has brought me the experience I had once hoped to get.

My work for the summer is focusing on HIV partner testing in Zambia. The study I am a part of is researching methods of partner testing in order to encourage male partners to get tested for HIV with the long term impact of reducing HIV prevalence and improving treatment. As the nature of my work is mainly qualitative, I am learning not only about the HIV partner testing method but about the cultural background, challenges, attitudes, beliefs, and approaches to HIV testing and care for people in Zambia. In addition, I am strengthening my skills with Nvivo, a software for coding data- a definite benefit for future jobs and research prospects.

My summer office.

My summer office.

Like any good learning experience, the practicum so far has not been without its tough moments. Zambia is six hours ahead of North Carolina, allowing for a narrow window in the morning for me to conference with my team. Unfortunately, it usually means either some team members have to stay later in the office or I have to wake up much earlier. Luckily, I work with a wonderful team and the coordination of schedules never feels burdening. With regards to reading transcripts, I went through moments of ‘culture shock’. The approach of HIV care with respect to social structure and norms is quite different there, with aspects I’ve never seen in both the US and India. My first reaction was automatically to question “How is that even acceptable?”, but with the firm reminder for myself in concepts of cultural humility and global practice, I have really taken it as a learning experience and I am continuing to enrich myself through this practicum.

Overall, the practicum so far has been amazing and I feel lucky to have been trusted for taking on this role. I look forward to working with my team and learning more!

Aditi

The Balancing Act of a Global Public Health Practicum Amid a Global Public Health Crisis

June 10, 2020 /

The COVID-19 pandemic has challenged us to change our attitudes and behaviors radically, as both students of public health and members of society.  Together, we are bound by our collective anxieties and feelings of uncertainty.  As students of the field, many of us have been frustrated with the shortcomings of our country’s infrastructure and feel overwhelmed as we take note of areas which call for improvement.  Some of us have felt a personal sense of responsibility to contribute to the response at home, whether that be to volunteer at our local health department or learn how to make DIY face masks from Pinterest.  Regardless of which emotion is most predominant on any given day, each of us feels a great sense of confidence as we see how necessary our skills are during these trying times.

The shared workspace of my husband and I.

The shared workspace of my husband and I.

Like other students planning a global practicum, I was disappointed when I learned that my position in Zambia would be shifted to remote work.  However, I am grateful that through the UNC Gillings Zambia Hub under the mentorship of Dr. Stephanie Martin, I am able to work with an issue which I am so passionate about.  I will be working with the Scaling Up Nutrition Learning and Evaluation project (SUN-LE) which provides survey, research, evaluation, and dissemination services to Zambia’s Scaling Up Nutrition (SUN) program.  SUN aims to reduce childhood stunting in Zambia through nutrition-specific and nutrition-sensitive interventions.  I will be working to provide quantitative and qualitative analyses of the cross-sectional baseline survey as well as key informant interviews to identify key indicators of childhood stunting.

My four-month-old puppy, Tanooki, enjoying our post-lunch routine of frolicking through Merritt’s Pasture.

My four-month-old puppy, Tanooki, enjoying our post-lunch routine of frolicking through Merritt’s Pasture.

By establishing routines, setting internal deadlines, and scheduling virtual check-ins with my preceptor, I hope to make my practicum experience feel as “normal” as possible – but that’s not to say that it won’t come with challenges.  My wily four-month old German Shepherd/Lab (mutt) puppy named Tanooki forces me to break up my day with periodic sprints to the mailbox and back – but I’ve been relishing in all outdoor activities.  From running and biking on the American Tobacco Trail, to fishing (so far, without success) at Jordan Lake and swinging in my backyard hammock, I have come to appreciate now more than ever how essential fresh air and movement is for my productivity and overall sense of wellbeing.

Grace

My Remote Practicum Experience During a Global Pandemic

June 8, 2020 /
Working from home.

Working from home.

I was beyond excited when I was able to secure a practicum with the UNC Gillings Zambia Hub. As this was going to be my first time in East Africa, I could not help but count down the days. I looked forward to my trip, the practicum experience and spending the rest of my summer holidays with my family (I last saw nine months ago) back home in Ghana. I went as far as checking on flights and almost booked a ticket. So, you can just imagine my shock and disappointment when the news of the rampant spread of the pandemic and the possible closure of the borders was all over. This probably has been the time when I have prayed the most in my entire life for normalcy to resume. I have had mixed feelings ranging from anxiety, uncertainties, boredom, and loneliness.  The good news is that I have been able to make adjustment to my daily routines and faced the reality of working remotely from home.

Zoom check-in from my preceptor, Dr. Martin.

Zoom check-in from my preceptor, Dr. Martin.

For my practicum, I am working with my preceptor, Dr. Stephanie Martin, on the project “Engaging partners and families in HIV-focused postnatal care” in Lusaka, Zambia. This is a qualitative, formative research study aimed at examining the feasibility and acceptability of engaging male partners, grandmothers, and other family members to support HIV-positive mothers to practice recommended infant care and feeding practices, and to continue antiretroviral therapy. This qualitative study employs the use of Trial of Improved Practices (TIPS) methodology, a formative qualitative research approach. For this study, data collectors will need to be trained on TIPs and to counsel women and their families on infant feeding, care, and stimulation, and women’s ART adherence. TIPS involves an interviewer and participant together reaching an agreement on a solution or solutions having analyzed current practices and how they could be improved upon. Participants are given a trial period to assess the feasibility and acceptability of the intended practice. I am, however, helping to prepare the documents for the upcoming data collection activities and participate in secondary analysis of qualitative interviews with women and their male partners in Zambia and Malawi to understand the role of male partners in the prevention-of-mother-to-child transmission of HIV (PMTCT).

Regular check-ins from Dr. Martin and faculty mentor, Dr. Sian Curtis, have helped me stay focused and encouraged. To stay productive, I have a work schedule that I try to stick to taking breaks in between. In order to keep sane, I have been going for walks, visiting the lake, and recently started baking.

Visit to Crabtree Lake.

Visit to Crabtree Lake.

Amidst the uncertainties, I am grateful for good health, loved ones both far and near, practicum and the opportunity to be working remotely. I would say this pandemic is a blessing in disguise because it has made me realize that tomorrow is never promised and has taught me to adapt to situations, making the most of every opportunity. A note to my future self would be that “I am stronger than I seem, smarter than I think, and I am capable of anything that comes my way,” because at the end of the day, it always works out!

Doreen

When Global Has to Be Local

June 5, 2020 /

In March, I signed an offer letter for a practicum position in Zambia, hoping to fulfill my bucket list item of moving to Africa. The day after I signed that letter, the announcement came that international travel would be prohibited for the summer of 2020. My goal is to attend medical school after earning my MPHand to then focus on surgery/oncology, so the position tending to women with gynecological malignancies at the Cancer Diseases Hospital in Lusaka was the perfect fit. I was anticipating a personalized internship in which I could follow patients throughout their treatment process, and work on the multidisciplinary team to implement an online dashboard system to better track patient progress. I am now doing all of this…from the comfort of my living room. The issue is, I didn’t want comfort. I decided to get my MPH at UNC specifically for the hands on practicum experience, but the world had other plans.

Throughout this process I am learning that the interconnectivity of the world due to globalization and technology allows global work to happen locally. It is quite amazing how a girl in Chapel Hill, North Carolina in the USA can be reporting the status of a patient about 8,000 miles away. These circumstances make me wonder about the future of global health, though. Will we be more inclined to take a comfortable seat in our living room directing the work of others across the globe? I believe there is inherent value in traveling to the locations and communities you mean to serve. It is necessary to do so to learn their genuine wants and needs instead of being holed up in the American South telling them what they should want and need. I believe this is an attribute of being a global citizen, one whose care is not restrained by national borders. It is my hope that this pandemic shows us how interdependent many countries are, especially with regards to public health and disease.

Through my work for the Zambian hospitals thus far, I have seen an example of a team of doctors who have a goal of following through, not letting patients slip through the cracks, efficiency, and executing quality medical care. It has impacted my career path because I am now affirmed that the job I have dreamed of since I was 16 is a reality. I plan to travel underserved communities to serve global populations by setting up a sustainable, efficient infrastructure and system of care. I am still grateful for the opportunities UNC has afforded me, even if they are remote.

Katerina

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The views expressed in this blog are the student’s alone and do not represent the views and policies of The University of North Carolina or the Gillings School.

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